What Medicaid Can Do for Our Nation’s Youngest Children

The science is clear: We have a critical opportunity to reach young children during a period of rapid development, with the brain forming one million new neural connections every second. These earliest years are full of possibilities equally as powerful as the vulnerabilities that greatly influence children’s lifelong trajectories. Anyone who’s had the pleasure of chatting with me the past two years knows my soapbox: To unlock these possibilities, we must do more to prioritize the needs of young children and their families in Medicaid.

The renowned Dr. Jack Shonkoff of Harvard’s Center for the Developing Child has said (paraphrasing here): The brain science is screaming at us. And…the future of improved outcomes young children rests in the healthcare system. This makes sense. A doctor’s office or health clinic is a key touch point for nearly every young child and their family before they enter school. But— with nearly half of ALL children under age 6 served by Medicaid or CHIP—I would revise this point to suggest that better outcomes for young children lie more specifically in Medicaid and CHIP.

While we know Medicaid is a key player, it can be challenging to get our hands around a direct path forward. As a policy ask, expanding income eligibility is relatively simple. Ensuring children get the right care at the right time? Not as clear. Medicaid is state-specific, complex, and has all that healthcare jargon to navigate. And while they’re the largest population served, children are the least expensive compared to other groups in a program often necessarily focusing attention on curbing costs. And of course, this is made all the more difficult in a tricky political environment where Medicaid is a popular punching bag. But young children have the most to gain from better access to preventive care and the right supports that can stave off bigger, more costly challenges as they age. Where can early childhood leaders begin?  

We set out to devise a proactive path forward in our latest installment of CCF’s Future of Children’s Health Coverage series: Promoting Young Children’s Healthy Development in Medicaid and the Children’s Health Insurance Program (CHIP). Recommendations include:

  • Prioritizing the health care of parents, future parents, caregivers, and early childhood educators as essential contributors to children’s healthy development. Quality of caregiver-child relationships is paramount. An obvious step here is expanding Medicaid to parents in states that have yet to do so (WITHOUT new barriers that undercut access to care, ahem). But it also means making sure all eligible parents are actually signed up—more than one in four eligible parents nationally is unenrolled.
  • Maintaining continuous, consistent health coverage for young children and their families. We can’t take coverage itself for granted—it’s not a box to check, ongoing effort makes a difference. Our initial look at 2017 Census data underscores this point: The uninsured rate for children under 6 went up significantly in just one year (2016 to 2017). That’s tens of thousands more young children missing check-ups and screenings. With the majority of uninsured children already eligible for Medicaid or CHIP, it is not time to scale back efforts to ensure all children get signed up and stay enrolled as long as they remain eligible. As Say Ahhh! readers may imagine, this recommendation has many options for federal and state policymakers, thanks to our annual enrollment survey with Kaiser.
  • Measuring and ensuring that young children receive the full range of services they need under EPSDT. Medicaid’s pediatric benefit (EPSDT) is comprehensive—much more so than for adults– and intended to ensure children get the preventive care and all medically necessary treatment required to prevent or improve their health. The first step is measuring whether children are getting what they need, when they need it. States should report the Child Core Set, seek to improve access to universally recommended preventive services (e.g. developmental screenings), and hold Medicaid managed care organizations accountable for performance standards that prioritize young children’s care.
  • Supporting expert-recommended, research-based interventions that meet the developmental needs of young children.  Does the state fully integrate AAP’s Bright Futures preventive care standards into Medicaid EPDST? Does the state make reimbursement policies and procedures clear for interventions linked to healthy child development (e.g. maternal depression screenings, home visiting, child-family therapy, care coordination, etc.). Federal guidance and state policy should reflect EPDST’s comprehensive benefit and also signal support for services that aid children’s development by also supporting their parents’ health.
  • Investing in prevention and pediatric care innovation as a key component of health reforms. States can take a comprehensive approach to serving young children in Medicaid by linking it to larger state reforms (see: New York’s First 1000 Days). Federal and state policymakers can do more to promote and test approaches that use the health system as the hub for families with young children—one important way to help Medicaid address social determinants of health. Medicaid can serve to both apply what we know and to also test new approaches to expand and apply our knowledge base.

These broad recommendations just scratch the surface—you can see more details in the paper, including a summary table on page 14 that outlines steps by federal and state actions. We hope this furthers the many national, state, and community-level conversations underway on the best ways to effectively serve young children and their families. Embracing Medicaid is not easy. And doing this effectively requires that Medicaid enter into authentic partnerships with other child-serving systems with a move toward cross-system accountability—also not easy. But unlocking Medicaid’s potential for young children is essential to put them on the best path for lifelong success. Let’s get started.


Elisabeth Wright Burak is a Senior Fellow at the Georgetown University McCourt School of Public Policy’s Center for Children and Families.